Table 3.
Table summarizing cases published to date of mycobacterial disease in patients aged <18 years who were exposed to anti-TNFα agents
| Pt | Ref | Primary disease | Anti-TNFα drug | Age/gender | Time on drug | Details on mycobacterial disease |
|---|---|---|---|---|---|---|
| Tuberculosis disease | ||||||
| 1 | [3] | JIA | Etanercept | NR | NR | Extrapulmonary |
| 2 | [3] | JIA | Etanercept | NR | NR | Extrapulmonary |
| 3 | [7] | Polyarticular JIA | Infliximab + MTX | NR | 2y | Asymptomatic miliary TB (MTB PCR positive in sputum) with good response to 9-month standard treatment |
| 4 | [8] | Systemic JIA | Etanercept → infliximab + (previous extensive immunosuppressive therapy) | 9y / female | NR | Subcutaneous cyst on the left wrist, after extensive microbiological studies, only MTB PCR in cyst fluid was positive. The child died after fulminant undiagnosed opportunistic pulmonary infection, 1 month after anti-TB drugs were implemented |
| 5 | [9] | Systemic JIA | Etanercept (previous CT and MTX) | 9y / female | 5wk | Ankle arthritis with positive MTB culture and normal chest X-ray; good response to 12-month standard treatment |
| 6 | [10] | SAPHO syndrome | Adalimumab (previous CT) | 17y / female | 3y | Meningeal and miliary TB presenting with septic shock; several PCR and cultures tested positive for MTB. Good response to therapy, but for neurologic sequelae. Adalimumab stopped 4 weeks earlier, suggesting immune reconstitution inflammatory syndrome |
| 7 | [11] | Polyarticular JIA | Infliximab (previous MTX) | 13y / male | 3 m | TB pleuritis (cultures negative) with good response to anti-TB therapy |
| 8 | [12] | Ulcerative colitis | Infliximab (previous CT and azathioprine) | 17y / male | 8 m | Miliary TB; the patient developed isoniazid-related hepatitis, but showed good response later on to an isoniazid-free regimen |
| 9 | [12] | Crohn’s disease | Infliximab | 13y / female | 2y | Disseminated TB disease with good response to 9-month standard therapy |
| Nontuberculous mycobacterial disease | ||||||
| 10 | [13] | Crohn’s disease | Infliximab → adalimumab (previous CT) | 12y / female | 9 m | Generalized lymphadenopathies due to culture-proven Mycobacterium avium complex infection; good response to ethambutol, clarithromycin and rifampin |
| 11 | [14] | Mother’s Crohn disease | Infliximab during gestation | 3 m / male | 36wk in utero | Bottle-fed. BCG vaccination at 3 m of age; disseminated BCGitis leading to death 6 weeks later |
BCG bacillus Calmette-Guérin, CT corticosteroids, MTB Mycobacterium tuberculosis, MTX methotrexate, NR not reported, PCR polymerase chain reaction, Pt patient, Ref reference, SAPHO synovitis acne pustulosis hyperostosis and osteitis